Current and former smokers—who comprise the vast majority of e-cigarette users—generally perceive e-cigarettes as less harmful than tobacco cigarettes, and as potentially helpful in their attempts at smoking reduction or cessation.1-6 (Refer Section 18B.7 for findings of research on efficacy for smoking cessation). Survey research in NSW found that the most common reasons for using e-cigarettes among smokers over 30 was “to help me quit” and to “cut down” smoking; for younger adults it was “because they are not as bad for your health as cigarettes”.7 An analysis of Australian and UK data from the 2013 International Tobacco Control Four-Country project found that, consistent with the country’s less stringent regulations, smokers and recent ex-smokers in the UK were more likely to perceive e-cigarettes as less harmful than cigarettes, compared to those in Australia.8

Among young people, e-cigarettes are similarly perceived as less harmful than conventional cigarettes, but also as less addictive.9, 10 One US study found that compared with never-users, youth who had ever or currently used e-cigarettes believed them to be not at all harmful or addictive, and were more likely to report flavoured products were less harmful than non-flavoured.9 Qualitative research in the UK found that adolescents perceive the products are ‘fun’, and find the diverse range of flavours particularly appealing.11 The wide range of sweet flavours is one of the most commonly cited reasons for experimentation among children, along with curiosity.12-15

Nonetheless, perceptions of harm appear to be increasing. Research in the EU found that between 2012 and 2014, the perception that e-cigarettes are harmful increased from 27.1% to 51.6%, although there were major differences between member states.16 Studies in the US have similarly found that the proportion of people who perceive vaping as less harmful than smoking has decreased over time.17-19 One found that the proportion of people who did not think vaping could help people quit, that thought vaping was addictive, and thought that vape was comparable to secondhand smoke increased between 2015 and 2016.17

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2.Bauhoff S, Montero A, and Scharf D. Perceptions of e-cigarettes: A comparison of adult smokers and non-smokers in a mechanical turk sample. American Journal of Drug and Alcohol Abuse, 2016:1–13. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27712126

3.Tomashefski A. The perceived effects of electronic cigarettes on health by adult users: A state of the science systematic literature review. Journal of the American Association of Nurse Practitioners, 2016; 28(9):510–5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26997487

5.Pepper JK, Emery SL, Ribisl KM, Rini CM, and Brewer NT. How risky is it to use e-cigarettes? Smokers' beliefs about their health risks from using novel and traditional tobacco products. Journal of Behavioral Medicine, 2015; 38(2):318–26. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25348584

7.Dunlop S, Lyons C, Dessaix A, and Currow D. How are tobacco smokers using e-cigarettes? Patterns of use, reasons for use and places of purchase in New South Wales. Medical Journal of Australia, 2016; 204(9):355. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27169972

8.Yong HH, Borland R, Balmford J, Hitchman SC, Cummings KM, et al. Prevalence and correlates of the belief that electronic cigarettes are a lot less harmful than conventional cigarettes under the different regulatory environments of Australia and the United Kingdom. Nicotine & Tobacco Research, 2017; 19(2):258–63. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27190403

10.Cooper M, Loukas A, Harrell MB, and Perry CL. College students' perceptions of risk and addictiveness of e-cigarettes and cigarettes. Journal of American College Health, 2016:1–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27805472